Yep - Lab Rats, One and All, That's What We Are

This is a response to Denise's latest comment. I thought it was worth exploring in more detail than a reply comment would suffice.

Denise,

First, I want to say how awful it is you had so many failed surgeries. It often seems we clubby's are guinea pigs for surgeons. Here is an unfortunate fact: there is no single body of evidence that addresses post-club feet issues as to what surgeries will be more successful than another surgery for the same issue - its all up to an individual surgeon to hopefully understand, and have the real skills, to both apply and succeed at that particular surgery. And we get to be their test subjects. As I keep saying, its all about the biomechanics - if there is an insufficient knowledge of both "normal" biomechanics and abnormal, then any approach to musculo-skeletal surgery stands a better-than-average chance to fail. And I would be more than happy to debate any surgeon on that statement, anytime they wish.

As for the orthotic question: Yes, by all means you should wear one on the non-club foot. This is because that foot is doing at least 1 1/2 times its normal job - it bears more weight (not 2 to 1, but still more - we tend to compensate, especially in the presence of pain,) it is firing its muscles with greater frequency (it needs to not only bear additional weight, it also needs to work harder to maintain balance, so it will have to fire those muscles more.) A properly made orthotic will aid in those increased functions.

However, you will still need something on the clubbed foot. Placing an orthotic beneath only one foot adds material, and therefor height, to that side. If you don't have the same material thickness beneath the opposite side, you induce a leg length difference. Now, that said, I have found most (not all) folks with a uni-lateral club foot already have a leg length difference, with the clubbed foot side being shorter. So, if you only add the same thickness, you may still be too short on that side. I urge you to seek out someone who has done a lot of work on limb length discrepency, which may not be so easy. Many doctors - orthopods, podiatrist, chiropractors - may say they "treat" limb length difference, but there's a small (not really) problem: few of those doctors really understand the proper ways to determine the true amount of the discrepancy, and even fewer understand how a specific uni-lateral pathomechanic anomaly may require adjusting what that amount means to any resulting treatment plan. Just because (assuming their measurements are accurate) you are measured with, say, a 1/2 inch discrepancy, failure to understand 1. the duration of the compensation your body has undergone (how many years have you been compensating,) 2. the specific biomechanics of the post-club foot; and 3. the manner in which you, specifically, have compensated for both the one post-club foot and the actual discrepancy, will nearly always result in some level of failure.

At minimum, you need to try for balance. I have found it almost always a more effective approach to be your own best investigator - its your body, you have to walk in it for the rest of your life, and you've already walked in it this long. So here is one thing you should try:

Get a stack of flat, hard objects, like magazines, but all of the same thickness. In your bare feet, and on hard flooring, place one of the magazines beneath your one clubbed foot, none under the other, for now. Stand straight, but relaxed. Allow your knees and hips to assume their most relaxed positions. Close your eyes, and get a sense of the position of your hips and knees, right to left. Pay attention to the position of your head, your arms, your spine. Are your arms at the same position right to left? Is your head tilted to one side, or is it level? You can try this in front of a mirror, but it is important that you not try to "correct" what you see - this requires being completely honest with yourself (we always unconsciously "adjust" ourselves when we notice something "off kilter.)

Once you have gotten that sense of your own body's position in space, step off the magazine and do the same thing with nothing under either foot. Note the difference. Now, replace the magazine with two of them, and do it again - check your body to notice the difference - does one hip feel higher, or one knee feel more "locked"? This will start to get you aware of how your body is balanced or unbalanced. The criteria are: both knees should be at the same, somewhat un-locked position. Your hips should feel level, and so should your shoulders. If you are standing in front of a mirror, do you notice any change in the tilt of your head, right to left?

There are more ways to assess leg length discrepancy, but these will start to help you understand how your body is either balanced or unbalanced. If you feel that one side is shorter than the other, the next test is to acquire a small piece of firm foam, like is found in shoe soling. Your local shoe repair shop is the best resource. Ask the cobbler to make you two shoe lifts for inside your shoes. One should be 1/8 inch thick, and the other 1/4 inch thick. Start with the thinner one - place it inside the heel of the shoe on the side you feel is shorter. Walk around with it in your shoe for no more than 1 hour (on your feet - sitting doesn't count:-) Use this for a few days, to evaluate how your knees, hips, back, and shoulders/arms feel. If you find there isn't much difference, exchange the lift for the thicker one, and do the whole process again. If you now feel a difference, slowly, no more than an additional hour each day, increase the time you wear the lift while standing and walking. If at any point in this process you start to feel pain in any part of your body, back off an hour or so, and make a slower break-in, until you are able to wear the lift without pain.

It may be that this is still not enough, that you in fact need more lift. But stick with this for now. Any additional amount really requires you get professionally evaluated, because what you don't want, is to create more trauma. So go slow - it took you this long to get where you are, don't expect to rush everything in the other direction without causing trauma to yourself.

Our bodies are masters of compensation, for many insults to our "bus." But not to all of them. If the bus gets a flat, it can be fixed. but if the bus drives into a ditch, its going to take much more time and effort (and money) to get it back on the road. But don't give up - just be patient, and always remember - you are the one driving this bus - only you can decide if the fix worked.